Hematopoietic Factors: Iron Deficiency Discussion

Hematopoietic:

Hematopoietic Factors: Iron Deficiency Discussion. J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days; lately, there have been 6 days of heavy flow and cramping. She denies abdominal distension, backache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):

Upon reviewing her medical history, the gynecologist notes that her Hematopoietic Factors: Iron Deficiency Discussion patient is a G5P5 with four pregnancies within four years; the last infant was delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she takes for her pain and how long she has been taking them, she reveals that she started taking ibuprofen, three tablets daily, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

Name the contributing factors on J.D. that might put her at risk of developing iron deficiency anemia.
Describe why J.D. might be presenting constipation and dehydration in the case study.
Why Vitamin B12 and folic acid are important for erythropoiesis? What abnormalities might their deficiency cause in the red blood cells?
The gynecologist suspects that J.D. might be experiencing iron deficiency anemia.
To support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
Lab results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe appropriate recommendations and treatments for J.D.

Cardiovascular

Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area, spreading the pain into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. En route to the hospital, the patient was placed on a nasal cannula, and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; it was 9/10 in severity; now7/10. In the ED, 3 SL NTG tablets did not relieve chest pain. He denies chills. Hematopoietic Factors: Iron Deficiency Discussion.

Case Study Questions

For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarction, describe the modifiable and non-modifiable risk factors.
What would you expect to see on Mr. W.G. EKG, and which findings described in the case are compatible with the acute coronary event?
Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
How do you explain that Mr. W.G.’s temperature increased after his myocardial infarction? When that can be observed, and for how long? Base your answer on the pathophysiology of the event.
Explain to Mr. W.G. why he was experiencing pain during his Myocardial infarction. Elaborate and support your answer.